﻿<%@ Page Title="" Language="C#" MasterPageFile="~/common/Admin.master" AutoEventWireup="true" CodeFile="applicant_details_accident.aspx.cs" Inherits="product_insurance_admin_applicant_details_accident" %>


<asp:Content ID="Content3" ContentPlaceHolderID="leftMenu" Runat="Server">
<ul>
    
   <ul>
     <li><a href="<%= Page.ResolveUrl("~/product/saving/admin/saving_apply.aspx")%>">
       Open Saving Account</a></li>
    <li><a href="<%= Page.ResolveUrl("~/product/card/admin/PendingApplication.aspx")%>">
        Debit Card Applicant List</a></li>
    <li><a href="<%= Page.ResolveUrl("~/product/insurance/admin/insurance_applicant_list.aspx")%>">
        Insurance Applicant List</a></li>
  
                   
    </ul>
                   
    </ul>
</asp:Content>
<asp:Content ID="Content4" ContentPlaceHolderID="content" Runat="Server">

 <h1>Power Saver Personal Accident Applicant Details</h1>
    <asp:HiddenField ID="applicationID" runat="server" />
    <asp:HiddenField ID="custId" runat="server" />

 <asp:FormView ID="Self_FormView" runat="server">
        <ItemTemplate>
 <fieldset>
        <legend>Particulars of Person to be Insured </legend>

        <table id="tbl_personalDetail" class="style1">
            <tr>
                <td class="style7">
                    First name:&nbsp;&nbsp;&nbsp;
                    </td>
                <td class="style6">
                    <asp:Label ID="lbi_firstName" runat="server" Text='<%# Bind("fName") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                </td>
                <td class="style5">
                    Last name:&nbsp;&nbsp;&nbsp;
                    </td>
                <td class="style4">
                    <asp:Label ID="lbi_lastName" runat="server" Text='<%# Bind("lName") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                </td>
            </tr>
            <tr>
                <td class="style7">
                    NRIC:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    </td>
                <td class="style6">
                    <asp:Label ID="lbi_nric" runat="server" Text='<%# Bind("NRIC") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                </td>
                <td class="style5">
                    Nationality:&nbsp;&nbsp;
                    </td>
                <td class="style4">
                    <asp:Label ID="lbi_nationality" runat="server" Text='<%# Bind("nationality") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                </td>
            </tr>
            <tr>
                <td class="style7">
                    Gender:
                    &nbsp;
                    </td>
                <td class="style6">
                    <asp:Label ID="lbi_gender" runat="server" Text='<%# Bind("gender") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                </td>
                <td class="style5">
                    Marital status:</td>
                <td class="style4">
                    <asp:Label ID="lbi_maritalStatus" runat="server" Text='<%# Bind("marital") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                </td>
            </tr>
            <tr>
                <td class="style7">
                    Date of Birth:&nbsp;&nbsp;
                    </td>
                <td class="style6">
                    <asp:Label ID="lbi_dob" runat="server" Text='<%# Bind("birth") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                </td>
                <td class="style5">
                    Occupation:&nbsp;&nbsp;&nbsp;
                    </td>
                <td class="style4">
                    <asp:Label ID="lbi_occupation" runat="server" Text='<%# Bind("occupation") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                </td>
            </tr>
            <tr>
                <td class="style7">
                    Have you been in Singapore for more than 182 days at the time of application?</td>
                <td class="style6">
                    <asp:Label ID="lbi_local" runat="server" Text='<%# Bind("longStay") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                </td>
                <td class="style5">
                    &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    </td>
                <td class="style4">
                    &nbsp;
                </td>
            </tr>
            <tr>
                <td class="style7">
                    Tel(H):&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    </td>
                <td class="style6">
                    <asp:Label ID="lbi_tel" runat="server" Text='<%# Bind("telephone") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                </td>
                <td class="style5">
                    Mobile:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    </td>
                <td class="style4">
                    <asp:Label ID="lbi_mobile" runat="server" Text='<%# Bind("mobile") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                </td>
            </tr>
            <tr>
                <td class="style7">
                    Email:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    </td>
                <td class="style6">
                    <asp:Label ID="lbi_email" runat="server" Text='<%# Bind("email") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                </td>
                <td class="style5">
                    &nbsp;</td>
                <td class="style4">
                    &nbsp;</td>
            </tr>
            <tr>
                <td class="style7">
                    Mailing Address: 
                </td>
                <td class="style6">
                    <asp:Label ID="lbi_mailingAddress" runat="server" Text='<%# Bind("address") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                </td>
                <td class="style5">
                    Postal code:&nbsp;&nbsp;
                    </td>
                <td class="style4">
                    <asp:Label ID="lbi_postal" runat="server" Text='<%# Bind("postalCode") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                </td>
            </tr>
            <tr>
                <td class="style7">
                    &nbsp;</td>
                <td class="style6">
                    &nbsp;</td>
                <td class="style5">
                    &nbsp;</td>
                <td class="style4">
                    &nbsp;</td>
            </tr>
            <tr>
                <td class="style7">
                    &nbsp;</td>
                <td class="style6">
                    &nbsp;</td>
                <td class="style5">
                    &nbsp;</td>
                <td class="style4">
                    &nbsp;</td>
            </tr>
        </table>
 </fieldset>
        </ItemTemplate>
 </asp:FormView>



<fieldset>
        <legend>Particulars of Family Members to be Insured</legend>



        <table class="style1">
            <tr>
                <td class="style18">
                    &nbsp;</td>
                <td class="style15">
                    &nbsp;First Name&nbsp;</td>
                <td class="style15">
                    Last name</td>
                <td class="style16">
                    NRIC/FIN/BC No.</td>
                <td class="style17">
                    Date of birth<br />
                    (dd/mm/yyyy</td>
                <td class="style13">
                    &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    Gender</td>
            </tr>
            <asp:Repeater ID="Relation_Repeater" runat="server">
                <ItemTemplate>
                    <tr>
                        <td class="style33">
                            <%# Eval("relationship")%> :
                        </td>
                        <td class="style36">
                            <asp:Label ID="lbs_fname" runat="server" Font-Bold="True" ForeColor="#0066FF"><%# Eval("fName")%></asp:Label>
                        </td>
                        <td class="style37">
                            <asp:Label ID="lbs_lname" runat="server" Font-Bold="True" ForeColor="#0066FF"><%# Eval("lName")%></asp:Label>
                        </td>
                        <td class="style38">
                            <asp:Label ID="lbs_nric" runat="server" Font-Bold="True" ForeColor="#0066FF"><%# Eval("NRIC")%></asp:Label>
                        </td>
                        <td class="style23">
                            <asp:Label ID="lbs_dob" runat="server" Font-Bold="True" ForeColor="#0066FF"><%# Eval("birth")%></asp:Label>
                        </td>
                        <td class="style35">
                            <asp:Label ID="lbs_gender" runat="server" Font-Bold="True" ForeColor="#0066FF"><%# Eval("gender")%></asp:Label>
                            &nbsp;<br />
                        </td>
                    </tr>
                </ItemTemplate>
            </asp:Repeater>


             
                <tr>
                <td colspan="2">
                    Occupation<br />
                    of Spouse:</td>
                <td colspan="4">
                   
                <asp:Label ID="lbs_occupation" runat="server" Font-Bold="True" ForeColor="#0066FF">
               
               
                </asp:Label>
                 </td>
                
            </tr>
               
        
              
            
        </table>



    </fieldset>
   <asp:FormView ID="Employer_FormView" runat="server">
        <ItemTemplate>
<fieldset>
        <legend>Details of Employer</legend>

        <table id= "tbl_employerDetail" class="style1">
            <tr>
                <td class="style8">
                    Name of Employer:</td>
                <td class="style9">
                    <asp:Label ID="lbe_name" runat="server" Text='<%# Bind("employerName") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                </td>
            </tr>
            <tr>
                <td class="style8">
                    Address of Employer:</td>
                <td class="style9">
                    <asp:Label ID="lbe_address" runat="server" Text='<%# Bind("employerAddress") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                </td>
            </tr>
            <tr>
                <td class="style8">
                    Nature of Employer’s Business:</td>
                <td class="style9">
                    <asp:Label ID="lbe_business" runat="server" Text='<%# Bind("business") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                </td>
            </tr>
        </table>

</fieldset>
       </ItemTemplate>
    </asp:FormView>
 <fieldset>
        <legend>Questionnaire</legend>
 
        <table class="style10">
            <tr>
                <td>
                    <asp:Label ID="disease" runat="server" Text="1. "></asp:Label>
                    1. Is any of the applicants have or ever had any disease, infirmity, illness or 
                    physical defect?&nbsp;
                    <br />
                    &nbsp; If yes, please give FULL name and details:<br />
                    <br />
&nbsp;
                    <table class="style8">
                        <asp:Repeater ID="Illness_Repeater" runat="server">
                            <HeaderTemplate>
                                <tr>
                                    <td>
                                        Full Name
                                    </td>
                                    <td>
                                        Details
                                    </td>
                                </tr>
                            </HeaderTemplate>
                            <ItemTemplate>
                                <tr>
                                    <td>
                                        <asp:Label ID="lbq1_name1" runat="server" Font-Bold="True" ForeColor="#0066FF"><%# Eval("fName") %>  <%# Eval("lName") %></asp:Label>
                                    </td>
                                    <td>
                                        <asp:Label ID="lbq1_disease1" runat="server" Text='<%# Bind("illness") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                                    </td>
                                </tr>
                            </ItemTemplate>
                        </asp:Repeater>
                    </table>
                    
                    <br />
                </td>
            </tr>
            <tr>
                <td>
                    <asp:Label ID="lbq2_hazardous" runat="server" Text="2. "></asp:Label>
                    Is any of the applicants engaged in anything hazardous in your/their occupation, 
                    sports or any other pursuits?<br />
                    &nbsp; If yes, please give FULL name and details:<br />
                    <br />
&nbsp;
                    <table class="style8">
                        <asp:Repeater ID="Hazardous_Repeater" runat="server">
                            <HeaderTemplate>
                                <tr>
                                    <td>
                                        Full Name
                                    </td>
                                    <td>
                                        Details
                                    </td>
                                </tr>
                            </HeaderTemplate>
                            <ItemTemplate>
                                <tr>
                                    <td>
                                        <asp:Label ID="lbq2_name1" runat="server" Text='<%# Bind("fName") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                                    </td>
                                    <td>
                                        <asp:Label ID="lbq2_hazardous1" runat="server" Text='<%# Bind("qstHazardous") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                                    </td>
                                </tr>
                            </ItemTemplate>
                        </asp:Repeater>
                    </table>
                    <br />
                    <br />
                </td>
            </tr>
            <tr>
                <td>
                    <asp:Label ID="lbq3_travelFrequency" runat="server" Text="3. "></asp:Label>
                    Is any of the applicants travel frequently? What is the frequency of these trips 
                    per year?<br />
                    &nbsp; If yes, please give FULL name and details:<br />
                    <br />
&nbsp;
                    <table class="style8">
                        <asp:Repeater ID="TravelFrequency_Repeater" runat="server">
                            <HeaderTemplate>
                                <tr>
                                    <td>
                                        Full Name
                                    </td>
                                    <td>
                                        Details
                                    </td>
                                </tr>
                            </HeaderTemplate>
                            <ItemTemplate>
                                <tr>
                                    <td>
                                        <asp:Label ID="lbq3_name1" runat="server" Text='<%# Bind("fName") %> <%# Bind("lName") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                                    </td>
                                    <td>
                                        <asp:Label ID="lbq3_travelFrequency1" runat="server" Text='<%# Bind("qstTravelFrequency") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                                    </td>
                                </tr>
                            </ItemTemplate>
                        </asp:Repeater>
                    </table>
                    <br />
                    <br />
                </td>
            </tr>
            <tr>
                <td>
                    <asp:Label ID="lbq4_declinedHistory" runat="server" Text="4. "></asp:Label>
                    Has any insurer in connection with Life, Personal Accident or Sickness Insurance 
                    ever deferred or declined your Proposal,refused or terminated an insurance or 
                    imposed special terms?<br />
&nbsp;If yes, please give FULL name and details:<br />
&nbsp;<table class="style8">
                        <asp:Repeater ID="DeclinedHistory_Repeater" runat="server">
                            <HeaderTemplate>
                                <tr>
                                    <td>
                                        Full Name
                                    </td>
                                    <td>
                                        Details
                                    </td>
                                </tr>
                            </HeaderTemplate>
                            <ItemTemplate>
                                <tr>
                                    <td>
                                        <asp:Label ID="lbq4_name1" runat="server" Text='<%# Bind("fName") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                                    </td>
                                    <td>
                                        <asp:Label ID="lbq4_declinedHistory1" runat="server" Text='<%# Bind("DeclinedHistory") %>' Font-Bold="True" ForeColor="#0066FF"></asp:Label>
                                    </td>
                                </tr>
                            </ItemTemplate>
                        </asp:Repeater>
                    </table>
                    <br />
                    <br />
                </td>
            </tr>
            <tr>
                <td>
                    &nbsp;</td>
            </tr>
        </table>
 
</fieldset> 
<fieldset>
         <legend>Details of Insurance</legend>
        <table class="style2">
            <tr>
                <td class="style3" >
                    Period of Insurance
                </td>
            </tr>
            <tr>
                <td class="style3" >
                    Insurance to commence: From
                    <asp:TextBox ID="tbStartDate" runat="server"></asp:TextBox>
                    &nbsp;to
                    <asp:TextBox ID="tbEndDate" runat="server"></asp:TextBox>
                </td>
            </tr>
            <tr>
                <td class="style3" >
                    Choice of plan&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                </td>
            </tr>
            <tr>
                <td class="style3" >
                   <table class="style24">
                        <asp:Repeater ID="Plan_Repeater" runat="server">
                            <HeaderTemplate>
                              <tr>
                            <td class="style28">&nbsp;</td>
                            <td class="style27">Plan Selected</td>
                            <td>Premium Level</td>
                            <td></td>
                        </tr>
                            </HeaderTemplate>
                            <ItemTemplate>
                             <tr>
                            <td style="color:#0066FF; font-weight:bold;"><%# Eval("fName") %><%# Eval("lName") %></td>
                            <td style="color:#0066FF; font-weight:bold;"><%# Eval("planType") %></td>
                                 <td>
                                     <asp:DropDownList ID="ddlPremiumLevel" runat="server">
                                         <asp:ListItem Value="1">Level 1</asp:ListItem>
                                         <asp:ListItem Value="2">Level 2</asp:ListItem>
                                         <asp:ListItem Value="3">Level 3</asp:ListItem>
                                         <asp:ListItem Value="4">Level 4</asp:ListItem>
                                        
                                     </asp:DropDownList>
                                 </td>
                                 <td><asp:CheckBox ID="cb_accept" runat="server" />
                                  <asp:HiddenField ID="hf_insuredId" runat="server" Value='<%# Eval("insuredId") %>'/></td>
                                
                        </tr>

                            </ItemTemplate>
                        </asp:Repeater>
                    </table>
&nbsp;</td>
            </tr>
        </table>

</fieldset>
<fieldset>
        <legend>Payment Method</legend>
        <table class="style2">
            <tr>
                <td>
                    Please charge the annual premium
                  
                    &nbsp;<asp:Label ID="lb_paymentPeriod" runat="server" 
                        Text='<%# Bind("paymentPeriod") %>' ForeColor="#0066FF" Font-Bold="True"></asp:Label>
                    &nbsp;to my Power Save Account.
                </td>
            </tr>

        </table>
        <br/>
       <P> Notes: 1) The premium stated is inclusive of GST and applicable for class I and Class II risks.<br/>
        &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
        2) Refer to underwriter for class III, decline or referred risks.</p>
    </fieldset>
    <br />
     &nbsp;&nbsp;</p>
    <p>
     <asp:Button ID="btngenerate_certificate" runat="server" Text="Accept" 
            onclick="btngenerate_certificate_Click" />
                        &nbsp;&nbsp;&nbsp;
        <asp:Button ID="btnReject" runat="server" Text="Reject" />
    </p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
    <p>&nbsp;</p>
</asp:Content>

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    function autoEndYear() {
        startDay = $('#content_content_tbStartDate').val();
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